Predicting Intracerebral Hemorrhage Expansion With Noncontrast Computed Tomography The BAT Score

被引：123

作者：

Morotti, Andrea ^{[1
]}

Dowlatshahi, Dar ^{[2
]}

Boulouis, Gregoire ^{[3
]}

Al-Ajlan, Fahad ^{[2
]}

Demchuk, Andrew M. ^{[4
]}

Aviv, Richard I. ^{[5
,6
]}

Yu, Liyang ^{[7
]}

Schwab, Kristin ^{[8
]}

Romero, Javier M. ^{[8
,10
]}

Gurol, M. Edip ^{[8
]}

Viswanathan, Anand ^{[8
]}

Anderson, Christopher D. ^{[8
,9
]}

Chang, Yuchiao ^{[7
]}

Greenberg, Steven M. ^{[8
]}

Qureshi, Adnan I. ^{[12
]}

Rosand, Jonathan ^{[8
,9
]}

Goldstein, Joshua N. ^{[8
,9
,11
]}

机构：

[1] IRCCS Mondino Fdn, Stroke Unit, Pavia, Italy

[2] Univ Ottawa, Ottawa Hosp Res Inst, Dept Med Neurol, Ottawa, ON, Canada

[3] Univ Paris 05, Ctr Hosp St Anne, DHU Neurovasc, Dept Neuroradiol,INSERM S894, Paris, France

[4] Univ Calgary, Hotchkiss Brain Inst, Dept Radiol, Dept Clin Neurosci, Calgary, AB, Canada

[5] Univ Toronto, Sunnybrook Hlth Sci Ctr, Div Neuroradiol, Toronto, ON, Canada

[6] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med Imaging, Toronto, ON, Canada

[7] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Boston, MA USA

[8] Harvard Med Sch, Massachusetts Gen Hosp, JP Kistler Stroke Res Ctr, Boston, MA USA

[9] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, Div Neurocrit Care & Emergency Neurol, Boston, MA USA

[10] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Serv Neuroradiol, Boston, MA USA

[11] Harvard Med Sch, Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA USA

[12] Univ Minnesota, Zeenat Qureshi Stroke Res Ctr, Minneapolis, MN USA

来源：

STROKE | 2018年 / 49卷 / 05期

关键词：

angiography; biomarkers; cerebral hemorrhage; hematoma; sensitivity and specificity; BLOOD-PRESSURE REDUCTION; HEMATOMA EXPANSION; SPOT SIGN; RISK; ASSOCIATION; GROWTH;

D O I：

10.1161/STROKEAHA.117.020138

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not routinely performed in the emergency setting. We developed and validated a score to predict HE-based on noncontrast computed tomography (NCCT) findings in spontaneous acute intracerebral hemorrhage. Methods-After developing the score in a single-center cohort of patients with intracerebral hemorrhage (n=344), we validated it in a large clinical trial population (n=954) and in a multicenter intracerebral hemorrhage cohort (n=241). The following NCCT markers of HE were analyzed: hypodensities, blend sign, hematoma shape and density, and fluid level. HE was defined as hematoma growth > 6 mL or > 33%. The score was created using the estimates from multivariable logistic regression after final predictors were selected from bootstrap samples. Results-Presence of blend sign (odds ratio, 3.09; 95% confidence interval [CI], 1.49-6.40; P=0.002), any intrahematoma hypodensity (odds ratio, 4.54; 95% CI, 2.44-8.43; P< 0.0001), and time from onset to NCCT < 2.5 hours (odds ratio, 3.73; 95% CI, 1.86-7.51; P=0.0002) were predictors of HE. A 5-point score was created (BAT score: 1 point for blend sign, 2 points for any hypodensity, and 2 points for timing of NCCT < 2.5 hours). The c statistic was 0.77 (95% CI, 0.70-0.83) in the development population, 0.65 (95% CI 0.61-0.68) and 0.70 (95% CI, 0.64-0.77) in the 2 validation cohorts. A dichotomized score (BAT score >= 3) predicted HE with 0.50 sensitivity and 0.89 specificity. Conclusions-An easy to use 5-point prediction score can identify subjects at high risk of HE with good specificity and accuracy. This tool requires just a baseline NCCT scan and may help select patients with intracerebral hemorrhage for antiexpansion clinical trials.

引用

页码：1163 / +

页数：27

共 26 条

[1] Systematic Characterization of the Computed Tomography Angiography Spot Sign in Primary Intracerebral Hemorrhage Identifies Patients at Highest Risk for Hematoma Expansion The Spot Sign Score [J].